Category Archives: Mental Health

While the transmission of HIV and the causes of HIV-related death are actually more complicated—and even more nuanced—than public discussion would let on, a few presumptions about it remain fairly accurate.

For women who are marginalized in their communities, who are victims of abuse or assault, and who are economically or socially dependent on a spouse, the risk of them contracting HIV or dying from multiple complications from AIDS is simply greater than that of women fortunate enough to not be subjected to these circumstances. Take these scenarios:

The power dynamic in an abusive relationship may prohibit women from being able to protect herself from a partner who refuses to wear a condom

Women in poverty and those who need to rely on a partner for financial support may have greater risk of comorbid infections than women of economic independence. They are less likely to have the health insurance and relationship with a healthcare provider that would support HIV testing and provide the essential—and expensive—HIV medications to ensure a healthy life and lower the risk of co-morbid infections

People without social support, living in fear of what an HIV-positive diagnosis means, or those who have reason to fear stigma around personal behavior when seeking treatment are less likely to know where to access treatment or seek it out because of that fear, stigma and lack of support

Common sense would seem to support these statements. But until recently, the pathways of infection were not always clear, and while the conclusions above seemed certainly reasonable, specific data to support them had been difficult to collect. Two recent studies led by a UCSF-researcher have changed that. One synthesized what is known about PTSD and exposure to trauma among HIV-positive women, and the other explored the root of this relationship.

The results were remarkable. HIV-positive women had between two and six times the rates of childhood and adult physical and sexual abuse, and PTSD. The snapshot of risk behaviors among HIV-positive women was sobering:

Sample size

Number (%) of participants with each characteristic

Sexual activity

Any sexual activity in the past 6 months

113

61 (54.0%)

With a main partnerMedian number of main partners (if any)

61

43 (70.5%)1 (range 1–2)

With casual partnersMedian number of casual partners (if any)a

61

23 (37.7%)1 (range 1–25)

Sex with any HIV negative or unknown serostatus partners (if sexually active) in the last 6 months

61

51 (83.6%)

Disclosure of HIV status less than all of the time with these partners

51

29 (56.9%)

Using condoms less than all of the time with these partners

51

31 (60.8%)

Detectable viral load

51

30 (58.8%)

Disclosure of HIV status less than all of the time, and using condoms less than all of the time, and a detectable viral load

There were striking findings in terms of both HIV treatment failure and the impact of the above risk behavior in these women, bringing us the first real data hoping to explain this relationship. Those who suffered from recent trauma had more than four times the odds of anti-retroviral (ART) failure while on treatment than HIV-positive non-victims—and this was seemingly not due to self-reported poor adherence to the medication. One potential explanation offered by the study authors is that abuse and trauma interfere with an individual’s ability to stay on a consistent medication schedule, which is essential for control of the virus. Other studies have confirmed that abuse manifest as control, in which a male partner prevents his HIV-positive female partner from accessing services at a clinic out of fear that the stigma of HIV would be attached to him.

HIV-positive victims of recent trauma also all reported experiencing what the study calls “coerced sex,” and have over three times the odds of un-traumatized women of having sex with HIV-negative or status-unknown individuals. They had greater than four times the odds of inconsistent condom use, potentially exposing those casual partners to the virus. While high-risk sex behavior is always a factor in HIV-transmission, HIV-positive individuals who adhere consistently to HIV treatments are significantly less likely to infect HIV-negative partners during sex. So the lack of treatment adherence among traumatized HIV-positive women combined with the risky sex behavior is a great concern.

Interestingly, these figures were only significant among women who experienced recent trauma, indicating that the ongoing—not merely one occurrence—circumstances of abuse are the key to the relationship between HIV-infection and HIV-related illness and death. This can actually be seen as a snapshot of hope—if we are able to offer abuse, assault, and PTSD victims the appropriate support to heal from the experiences, we may be able to weaken the HIV/trauma relationship.

These studies draw a clear line between victims of assault and trauma and both the spread of HIV within their communities and the increased risk of HIV-related illness and death. But interestingly, the risk goes much deeper than these socioeconomic circumstances. The conversation around HIV transmission is generally split into one of two categories: social and behavioral—risky activity, injection drug use, the prejudicial judgment of sex workers; and medical and clinical—how the virus infiltrates the immune system, takes over cells, and how it is and isn’t suppressed with antiretroviral medications. What isn’t usually discussed is the possible combination of these two categories and how together they create a perfect storm for potential infection.

Recent studies have shown that those individuals suffering from PTSD had significantly higher rates of cytomegalovirus (CMV) in their body. A virus that is found in between 50%-80% of adults in the United States, CMV remains largely undetected—latent, suppressed, unproblematic—in healthy individuals. It’s also seen as a marker of immune health and function, and of the body’s ability to control potential infections. Given that 30% of American women with HIV/AIDS have PTSD (five times the national average), the potential relationship between their HIV-status and even further compromised immune function could lead to a myriad of comorbid infections and premature death. Other research has also shown that additional biological mechanisms may prevent ART-treatment from being as effective as possible, including high cortisol (stress hormone) levels. Not only do these victims have to fight against abuse and assault, they have been left without the essential social support to decrease risky behaviors that may expose others to the virus, and their own bodies are in revolt.

Collecting this kind of information is difficult. It requires consistent and positive communication between women and providers, unobstructed access to medical care and uninterrupted ART treatment, and of course, in this example, most importantly—removal from an abusive environment.

The combination of immunosuppression due to PTSD, the detectable rates of HIV in traumatized women whose viral loads are not suppressed by consistent anti-retroviral treatments, and the concurrent risk behaviors of abused HIV-positive women, all contribute to higher rates of HIV-infection in communities, as well as the potential for co-morbid infections and HIV-related death. Until these women are able to find the essential social and community support, free from abuse and trauma, and until their access to care and preventative measures are fully realized, the relationship between trauma and HIV will only deepen.

I listened to a great NPR report this afternoon by Jenny Gold about juvenile detention centers and how they’re missing some key indicators of the health status of girls that enter into the system. As someone specializing in adolescent girls’ health, I was pretty fascinated – it detailed the personal experiences of a few girls being seen in a New Mexico facility and also tried to address ways it could be rectified. Detention centers can actually be helpful entry points for girls and young women to be connected to healthcare resources (we’re talking mental and physical health, so everything from counseling to substance abuse help to medical attention if they are victims of assault or violence or have seen physicians only irregularly).

One of the biggest issues facing these girls was confidential disclosure of their health status and any social, emotional, and physical issues they were facing. Developing rapport with a provider at a detention facility can be difficult in and of itself, but the girls reported having to answer personal questions in an open-door location, often with men and boys – staff or other teens – present; unsurprisingly, this made it difficult for many girls to feel that they could answer questions of a personal nature (sexual behavior, drug and alcohol use, history of assault, abuse or violence) honestly and openly. What we do know about these girls – 41% have vaginal injury consistent with sexual assault, 8% have positive skin tests for tuberculosis, and 30% need glasses but don’t have them – shows that getting all of this information early on is essential for appropriate and timely care.

One proposed solution to this – getting as much information as possible from these girls about their health status and the best ways to then help them, treat them, and connect them with resources – was to have them fill out a survey themselves. Currently, girls are asked 35 questions by an intake nurse when they arrive, that cover things like current medications, alcohol or drug use in the last 24 hours, and whether they have a history of self-destructive behavior. The proposed survey in the New Mexico facility is 132 questions, and according to one facility employee the time that would take is just not feasible given the traffic and business of the facility. Researchers and providers implemented a pilot study of the survey for 30 girls at the detention facility.

Of course, I can’t comment on the actual level of frantic activity in the specific facility at hand, but I can say that having a questionnaire that catches health issues which can be immediately and effectively addressed can prevent a host of issues from getting worse as time goes on without treatment – potential injuries from abuse or assault, needing STI screenings for victims of rape or girls who are sexually active without access to contraceptives or regular gynecological care, and of course mental health resources and immediate connection with social workers or therapists for those girls in need. Either having the girls fill out the survey via computer themselves or having a nurse help them would also be enormously helpful in the long run. This can also be a great way to track the care progress of these girls over the years, as many go in and out of detention centers. For girls who have experienced assault or abuse or multiple infections and injuries, this can be an easy way to follow-up with them without having to go through essentially baseline assessments of their well-being every time they enter a facility.

Some of the sobering stats about the girls from this particular New Mexico facility from this report: Of the 30 girls who participated in the piloting of implementing this survey, 12 needed immediate medical care, and 23 were coded as needing medical care within 24 hours, based on the survey’s questions. Intakes without this survey missed essential things, like burns on one girl’s torso and chest.

Check out the whole report here. I have no doubt that detention centers are in dire need of additional resources and likely way more staff than they have, for more than just this particular issue of adolescent girls’ health, but if the issue is there being one nurse for multiple intakes, having the girls fill out the survey on a computer themselves – when they’re more likely to be honest than in discussion with a nurse anyway, seems like the best solution to these kind of initial entry screenings. Especially since poor physical health is an indicator of recidivism, increasing the likelihood of girls ending up back in a facility.

I know it’s been a while since I’ve written – I took six weeks off to finish my dissertation and prepare for its defense (I passed!), and to take a bit of a breather after all that required writing! But what better way to start a new month than with a new post?

One of the many reasons I went to graduate school to study adolescent female and women’s health was because I wanted to gain a better understanding of why women and girls develop disordered eating behaviors, what makes them worse, and most importantly, how to prevent them. And more and more studies are telling us what many researchers, clinicians, and patients themselves have been telling us for years.

A few recent studies in particular that have been published in the past few weeks highlight these issues well. One new study out of UCLA has again proven that strong self-perception is key to the prevention of risky behaviors in teen girls. The results of this study showed that overweight girls who had high body satisfaction and who were happy with their size and shape were less likely to engage in a range of unhealthy and disordered eating behaviors like fasting, skipping meals, and self-induced vomiting. And more importantly, the study also showed that these girls had lower rates of anxiety and depression, which are so disturbingly common among girls with burgeoning eating disorders.

And the best thing about the study’s results was the discussion that these public health experts, dieticians, and professors had, in which they emphasized that for effective, healthy weight-loss interventions for teens who may need to lose weight for real medical reasons (preventing the onset of diabetes or hypertension and increasing cardiovascular health, for example), these programs need to be rooted in positive self-esteem and the enhancement of self-image. When you feel better about yourself, you want to keep taking care of yourself. You are also more likely to want to share yourself with others, and creating positive social networks increases the likelihood that people will have supporters pushing them to stay healthy as well as a community that makes them feel worthwhile, appreciated, and worth the kind of self-care that diet and exercise changes require.

So why do companies, organizations, media outlets, and other vocal critics keep harping on the idea that shame, insults, and bullying will help people lose weight? To me, the root of this problem lies in the misguided thought that anyone else’s weight is anyone else’s business. It isn’t.

Another recent study has unfortunately shown something I find really upsetting. Preschoolers – remember, that’s ages 2-5 – show negative perceptions of overweight children. The way this study was conducted involved an adult reading four different stories to a group of children, in which one character was ‘nice’ and the other was ‘mean.’ They then showed the children pictures of one overweight figure and one normal weight figure, and asked them to select which one was the ‘nice’ character from the story and which was the ‘mean’ character. Nearly half of all students said that in all four stories, the overweight figure was selected as the ‘mean’ one. Mind you, these figures had no faces. No physical expressions. One was just bigger than the other. And because of that, the children thought they were meaner.

I mean…whoa. Ages 2-5 are in the early developmental stages, when children are absorbing and processing and incredible amount of information – verbally, visually, and physically – and learning how to reason. We do not need judgments about others’ weight getting ingrained at this age, creating perceptions that are very difficult to change. Of course, this one study bears repeating, and should incorporate additional measures of exploring these outcomes; nonetheless, these results are troubling.

Of course, this study begs the revisiting of one of my most pressing points on this blog. Weight, just like food, is not a characteristic that is inherent in measures of good versus evil. That’s very dangerous territory to traverse – once one allows weight to dictate the assessment of whether or not someone is not only of value and worth (societally speaking, this already happens, when overweight people are ignored, more easily dismissed, not taken as seriously), but whether or not they are actually truly ‘bad’ or ‘mean’ or capable of certain sins because they are overweight, one’s morality becomes game for critics. I also always remain shocked at some critics’ short-sightedness in this relam – if you yourself gain weight in the future – something which may happen for a variety of reasons – are you readily willing to take on the label of weakness, ‘meanness’, gluttony? The impassioned rhetoric around the blaming and shaming of overweight people is so starkly in need of an infusion of compassion.

What this shows is that children are inundated with messages, both direct and indirect, from so many different sources at such a young age, that the idea of being overweight is coded as bad in so many ways, that it seems nearly inescapable. To me, this means we have to keep making intense efforts to combat these messages, because we are climbing one steep hill.

5 Feminist Demands She Wants You to Ignore hits the viewer with a most beguiling shot of a woman with obviously…supplemented breasts, ostensibly begging you to ignore any “demands” she makes for equality and respect. The first “demand” to ignore, while not articulated, given the intense cosmetic restructuring of her chest, may be “confirm the beauty of my natural self and do not reward silicone implantation.” (I will soon in the future write a post about how the claim “they’re for me” in regards to a woman getting breast implants is not a sustainable argument since one does not gaze for hours in distaste at their own breasts and determine they fall short of beauty unless they have been conditioned to think that their breasts, for whatever reason, do not fall within the confines of socially determined acceptability and attractiveness.)

Moving on. When you’re a man out on the prowl, you’re going to encounter some “independent ladies,” the article warns. (Independent ladies is put in quotes to make sure you understand, as the male reader, that independence is tenuous at best, for show, a joke, an adjective easily swept aside by a proper man.) Sexy feminists aren’t “entirely false” (thank you, Fox, and AskMen, for validating our sexuality), but you still must tread carefully – because as women, we never “ask for what we really want.” An entire gender rooted in the goal of misguided and cloaked communication. What to do?

Number one demand feminist want you to ignore: “I can carry my own bag.” Little to be said here because I have never heard a woman actually say this, but also because being polite and helping someone if they’re carrying quite a burden is not actually an issue that needs to gendered. Feminists never did gender this, the claim of “I can carry my own bag” was picked up as a mocking of women who wanted recognition of the fact that they weren’t helpless.

Number two: “Don’t objectify me!” This goes hand in hand with my opener. Of course, this has been misappropriated over and over again by anti-feminists, or those who want to warp the message. Paying someone a compliment is not objectification, which is how this ‘article’ is defining it – objectification is equating the person’s worth with what you see. If the compliment of her looking great in her dress means that looking great in a dress is all she does/is, then that’s a problem. Also, straight up calling women liars if they aren’t impressed by compliments about their appearance is a great way to puff up one’s ego, but trust me – there are plenty of women who really don’t care what your thoughts are about their looks.

Number three: “I’ll pay my share.” Misses the point entirely – first, a woman’s vested interest in keeping a relationship financially balanced is different than treating your girlfriend to an expensive dinner sometimes. Especially because they insist that if she doesn’t return the favor by treating you sometimes (ahem…sort of like splitting the cost? In essence…paying her share?), then you should withhold such a generous gift (and I guess have her pay her share?). Playa’.

Number four: “I can think for myself.” This one is great. Even “high-powered women want men to take the reins sometimes,” which to the authors means…thinking ahead about dinner plans? I love that taking the reins means making sure you know what you want to have for dinner. Not even making dinner. Just…knowing what you want to eat. If this is what it means to wrest control from women who are thinking for themselves, I encourage women everywhere to resist.

Number five: “I won’t be shackled into a marriage.” The authors admit that there are apparently “exceptions” to the steadfast rule that women want to be married and instead of acknowledging that both men and women may have changing and evolving priorities, they encourage readers to merely brush off a woman’s thoughts on this matter if they initially refute the general equation of ring/house/baby that will ultimately overcome these ladies.

It goes without saying that this is a heteronormative perspective, not only strictly defining what is ‘female’ and what is ‘male,’ but also emphasizing that women are feminine and men are masculine, and, you know, case closed. Interestingly, they claim at the end that “gender roles evolve everyday.” Which would make one think that the entire preceding article was, indeed, unnecessary at best. Of course, they then close with: “women are a complete contradiction in terms and that’s one thing they’re likely to never evolve out of – like men and leaving the toilet seat up. We all have our crosses to bear.” There you have it! Women can’t make up their mind and never know what they mean, and men are just disgusting. Why resist nature? Thanks for clearing this all up, Fox News. I can always count on you.

But nonetheless, the way the domestic abuse issues in Taylor’s marriage were drawn out and discussed on last Monday’s Real Housewives of Beverly Hills merits a bit of a chat.

I don’t want to do any scolding because I tend to think there’s a lot of misinformation about domestic abuse and intimate partner violence, and the women of this cast seem to be trapped in the bubble of the misinformed. The entire episode was pretty hard to watch (nothing new there – look at what I put myself through just so I can analyze media!), not least of all the immensely uncomfortable tea party scene. It started with Adrienne and Paul (I’m sorry I can’t stop to explain every character, if you aren’t as fascinated by this as I, see bios on the BravoTV site), having a celebratory dinner and Adrienne broaching the subject of Taylor’s fragile state. The sincerity of this concern is hard to gauge, as is the sincerity of anything on these shows, but she seems to wonder why Taylor seems to be on the verge of a breakdown 24/7, and tentatively brings up that Taylor had told some of the other ladies that her husband, Russell, was physically abusing her. The revelations are, of course, greatly illuminated by Russell’s suicide this past summer, after which his history of abuse became more prominently displayed above the fold of tabloids. Paul’s response to this was “Nah…I know Russell. I just don’t believe it, he’s a great guy, he wouldn’t do that.”

The speculation continues at the tea party, which was so unsettling in no small part because it truly appeared to be the pinnacle of Taylor’s undoing. She seemed exhausted and overwhelmed, very much on the edge. She was breaking down, and it was painful to watch.

The women kept saying they didn’t know what to believe because they had never seen the abuse, they had never seen Russell hit Taylor. But moments later, Camille exclaims that they all knew of her injuries – at whose hands did they assume her jaw had been broken or her face smashed in, as they referenced? Not the man with two restraining orders against him from former wives and girlfriends, and with a record of beating his first wife when she was pregnant?

People generally don’t witness domestic violence. People generally don’t witness rape. We know they occur. Abusers frequently seem like charming, engaging, or friendly folks to the outside world. So do many criminals. This is a kind of control tactic, in which the victim’s testimonies can be negated by the public reputation of the abuser. Ted Bundy’s neighbors testified that he was a generous family man, but whoops, in his spare time he brutally kidnapped, raped, and murdered over 30 women. Appearances can be deceiving. We all know this, and we must get past the assumption that someone who presents themselves publicly in one way can’t have an entirely different private persona. Russell seems to have quite a violent history, and abuse allegations are rarely isolated. Personally, the footage of Russell I’ve seen has made me uncomfortable, as it always seemed controlled rage was simmering just under the surface. He didn’t like to leave Taylor with her friends, and I recall last season that when they were on a trip to Vegas he had her leave with him when he wanted to remove himself from the party instead of allowing her to socialize. Seemingly small actions like this can often be part of a larger orchestration of control that the abuser holds over the abused – particularly in regards to isolating them from their networks.

The tea party mock intervention continues, as Adrienne then claims she can’t get her head around someone who just doesn’t leave a man who is abusing her and putting her daughter at risk. She says this in a frustrated tone, as though Taylor is weak, weaker than them, because she didn’t stand up and walk out. She says, in fact, that she doesn’t understand where Taylor’s “willpower is.” This shows grave misunderstanding of the dynamics of partner violence; Adrienne is certainly not alone in thinking this.

People don’t leave because they’re terrified. Because they are not financially and economically independent. Because they’re worried the abuser will find them and the abuse will be even more intense, more vicious, possibly result in their death. Because they’re embarrassed and humiliated or are worried about more people discovering the truth. Because they have survived by protecting themselves with rationalizations and forms of denial, and leaving means confronting an overwhelmingly scary reality that often induces post-traumatic stress and requires a steady, uncompromising support system. Because they are used to a cycle of violence, followed by intense proclamations of love and dedication from the abuser, followed by manipulation, followed by violence again. Because they feel trapped. Because they have often been isolated by the abusive partner from their friends and family.

Taylor likely felt all of these things. She herself expressed that she had been a child in a home rife with domestic violence, and we know that children who witness abuse are more likely to have it replicated in their own marriages. She was married to an extremely powerful man in Los Angeles, and was likely worried that his status would aid in making her independent search for a job, home, and new social circle, exceedingly difficult. She appears to have no significant familial relationships to which she could reach out and seek refuge, her group of friends don’t have the reputation of being particularly warm and welcoming. She probably worried about what would become of her daughter – what if her daughter was targeted by Russell when they left? She may have been embarrassed, that’s not uncommon. She may have wanted to avoid being called exactly what some people seem to already assume – weak. She may have worried that people would wonder about her character and why she had chosen this person if he was abusive. She may have worried that, very sadly, she deserved it. Especially if it was a behavior she was used to witnessing as a child. She may have thought, concerningly, that no one would believe her. People aren’t believing her now, which likely confirms her earlier concerns; she may have thought she would be worse off if she were traversing a world by herself, 5 year-old daughter in tow, with everyone thinking she’s a liar. She probably was lured back into the relationship by the very cycle of domestic violence so many victims and survivors are familiar with.

Perhaps some individuals think if they were in Taylor’s shoes that they would be “strong” enough to leave. The reality is, domestic violence is a deeply complex issue, and it is very difficult to assume how one might handle the situation given how complicated it is.

An egregiously irresponsible “article” snidely remarked that Taylor didn’t want to lose Russell’s money, and that’s why she didn’t come forward. I’m the first to point out the materialism of this series franchise, but in the case of an abuse victim, it has less to do with fear of losing one’s jewels and furs than it does with fears of losing one’s life. And concerns about caring for a child on their own, concerns about the community siding with the abuser and icing her out, concerns about getting a protection or restraining order, concerns about being stalked. Her coming out and being more explicit with the abuse details after his death is indicative of how terrified she likely felt. If she had previously come out as publicly as she recently has, I’m sure she felt that the consequences at the hands of Russell could have been far greater.

In short (or not so short), this episode could have come with a Bravo TV PSA after its airing. But then I wouldn’t have been able to write this.

I wrote about the Yoplait commercial that was pulled from the air a few weeks ago in a post that had some hope for a change of tune for the company. It seemed that given the outcry – from media critics to the National Eating Disorder Association – Yoplait understood that their presentation of an anxious and panicked woman weighing whether or not she was “good” enough to eat a piece of cake and how many pieces of celery she would punish herself with in return for this ghastly ingestion was both triggering and normalizing. Triggering for people who may have experienced battles with eating disorders in the past, and normalizing for those who may be on the cusp of such a struggle, ensuring them that their mental calculations and rewards were right on par with the rest of America’s women. I also saw the danger in the potential of the commercial subtly instructing young women that this kind of anguish over food was what they had to expect and look forward to in their future, thereby setting them up for young failure. (I want to note that I am not excluding this commercial’s impact on the men who suffer from eating disorders, I am emphasizing women here because of the construct of the commercial and the genders of those who were featured in it.) I’ve also discussed advertising’s effect on behavior elsewhere, and I think this post addresses some of my previously articulated concerns.

However. I fear I wrote with hope a bit too soon. Another of Yoplait’s popular commercials smacks me between the eyes every couple of days, and while it’s certainly not as yougottabekiddingme as the one with the celery champion, there is still a real issue here:

Classifying some foods as “good” and vilifying others as “bad” sets one up for failure in a most beautifully orchestrated series of events. Certain foods may be healthier for you than others, but like most things, foods do not carry with them an innate characteristic of innocence or evil. In giving foods these kind of descriptions, they take on anthropomorphic identities that make it easy for one to associate with themselves. If cake = bad, and I consume cake, then I have consumed bad, ergo me = bad. Cake isn’t “bad.” It’s sweet. Sometimes sugary, sometimes tart. Sometimes in cup form. It isn’t “bad.”

And of course, you will eat cake at some point. Or a cookie, a brownie, a pie, pick your pleasure. If you don’t like sweets but are trying to calorie cut like a pageant contestant, perhaps it will be bread, or all carbs, or any drink other than water. Trying to eliminate the consumption of something either enjoyable (cake) or necessary (you know, food in general), the abstinence of which upon you have hinged your self-worth, leads you down a dark path resulting in you equating yourself with a monster when all you did was have some dessert.

While I noted above that men also suffer from eating disorders (they comprise about 10% of eating disorder cases), this commercial also does nothing to fight and everything to reiterate one of our oldest gender stereotypes. A woman obsessing over food and calorie counts and thinking herself to be deserving of punishment if she fails the arbitrary, socially sanctioned test of true character – resisting cake and losing weight! The fact that someone as talented as Jennifer Hudson recently articulated that her weight loss was more of an accomplishment than her Oscar shows just how far the socialization of this absurd test of character has gone for women and girls. Making the resistance of a slice of sheet cake the high point of one’s day (or the accomplishment of your life) really diminishes the much more astonishing achievements one is capable of.

Losing weight can be a healthy goal for a lot of people if they are at risk for complications like diabetes, heart disease, or high blood-pressure. But it isn’t everything – which is what most media messages seem to think it should be. If you’re trying to lose weight, talk to your physician about nutritional guidelines and an exercise plan. And first, clarify if you need to lose weight at all. I suspect that many of you don’t, but have been informed by a bear sheriff that you do not meet the specifications of his ideal woman.

I got a lot of traffic and messages about my recent post regarding Duke Nukem. People in the gaming community condemned it for its lack of originality, how it strayed from the original premise of apparently ostensibly mocking the ’80s action-hero genre, and how it overall disappointed those who are used to more complex and engaging videos. Some replies also included people needing to “get over it” when discussing images of coerced sexual activity or the game’s encouragement of merging violent and sexually explicit content together (I don’t post comments that are condescending or don’t encourage dialogue), something I found…disturbing. My initial argument, however, did not change – that is, that the imagery and the actions the gamer supposes in this video are tragically abusive and in fact detrimental to both men and women.

A well-known study published in the Journal of Consumer Research found that repeated exposure to images and advertisements ultimately were processed in people the same way actual experiences were processed. That is, if you see or watch something enough times – in a video game, in a fashion magazine in which models are photoshopped to near obscurity, in a parent abusing your sibling – you begin to process it as though it was you yourself experiencing the act and identify with the “player” (model, game character) you are watching. You see enough pictures of a model like this:

Courtesy fashion-o-lic.com

And you begin to think you are supposed to align yourself with her, that this image is what is normal (the image on the right was criticized heavily in 2009 for being so drastically photoshopped). After so many exposures, you begin to mold yourself after her, to think that since this is how we project women for adoration in our culture, that you should begin appropriating yourself to match her image. Just like a gamer, after so many exposures, can begin to mold themselves after the image of the character they are impersonating in a game. And while they may not go out on a shooting spree, they are desensitized to the effects of that reality, just as they are desensitized to the effects of coerced sex in a game, which can lead to difficulty distinguishing that from a healthy sexual relationship.

We’re humans. We learn by watching, by then mimicking and imitating what we observe. It doesn’t happen all at once, which is why fashion moguls or game designers claim they have no real impact. Are girls entering periods of self-mandated starving as soon as they open this month’s Vogue? Are adolescent boys heading to the hills for a sawed off shotgun fight after the first round of Duke or stealing cars after playing the new Grand Theft Auto? No, of course not. But can it impact their sense of compassion, affect their interpersonal relationships? Can it make violence seem less threatening, less damaging, and less impacting than it is? Yes. Can that change the way people behave, from nuance to imitation? Sure. Even researchers who admit that it won’t necessarily turn children violent admit that’s likely true (and, interestingly, still disallow their children to play). Human development takes time – language acquisition, understanding of and the processing of visual messages, being able to comprehend meaning from a block of text – these are all cognitive functions that take years to develop and perfect, and their influence lies in the words and actions of children’s families, friends, teachers. Unfortunately, messages of gender have been largely commandeered by the media. And the repeated exposure, over years, to these specifics of models’ physical appearance has resulted in the erosion of self-confidence that many girls and women – and boys and men – experience as young children becoming adolescents. And the repeated exposure, over years, to the specifics of war, sexual violence, and the presentation of hyper-masculinity, can also result in the erosion of what kind of impact violence truly has, as they become desensitized, and what a healthy understanding of and relationship with the opposite sex is (as opposed to its portrayal in my Duke Nukem piece). As the study articulated, it’s about changing people over time, it’s about how perceptions and perspectives change when a new definition of the norm that is not contested or dissected – a Ralph Lauren model, a Duke Nukem – enters the picture. Women who suffer from eating disorders and body dysmorphia, while not blaming the fashion industry, have emphatically articulated that it certainly has had an impact as it normalized this destructive self-image and behavior.

I think it’s also relevant here to bring up the Supreme Court’s decision about a week ago to shoot down California’s attempt to ban the sale of violent video games to children. Timothy Egan, a Times columnist, had a great commentary on this, noting how ridiculous it seems for there to be a perpetual ban on nudity and sexually explicit images, but not on virtually dismembering a human or sexually assaulting a woman. It does seem…well, more than troubling, that a game in which a player can simulate murder and rape is protected by free speech but a bare breast is the height of vulgarity. (I found a great post from a female gamer about this kind of sexual violence in video games, and I agree with her assertion that sexual expression can in fact exist without it also involving violence and degradation.) I don’t think any of the representations of sexuality that I have seen in video games are appropriate for children because they overwhelmingly associate it with abuse and/or coercion (I’ve done a lot of viewing in the past couple days after my Duke Nukem post). To say that sexuality would have a more harmful impact than violence seems questionable, when representations of both are equally unhealthy.

It should also be said that I am far from someone who believes nudity and sexuality itself is vulgar. I celebrate and support healthy (and protected!) sexual expression in any way the individual consents and desires. I firmly believe that discussions of sex and sexuality should be brought up early on, so children can ask questions, be informed, protect themselves when they do engage in sex, and have an understanding of what a respectful, consensual sexual relationship is. I also believe that when these discussions in families don’t take place, and when sex is a taboo topic, that it is a disservice to these children, and that any confusion they have about sex or uncertainty about what a healthy sex life actually is will be magnified by the messages the media sends them. I’m an advocate of early onset, comprehensive sexual health and reproductive health education. Sex shouldn’t be confusing, and it shouldn’t be stigmatized. Sexual violence, however, and a misappropriation of the presentation of sexual relationships that are abusive, coercive, and violent, should be condemned.

This is also why a diversity of exposures is important. It’s important to not be inundated with the same message over and over again. Advertisers know that repeated exposure is key to getting people to buy what they want to sell. If you see an image of a Coke bottle once, it won’t register with much impact. If you see it every time your favorite TV show breaks for commercial, when you’re leafing through the pages of a magazine, when you’re driving down a freeway and it’s up on a billboard, when you’re listening to the radio and it breaks for the Coke jingle – it adds up, as do afternoons in front of a game console, as do hours reading “women’s” magazines and fashion spreads, as do episodes of spousal or child abuse, (which we know increases the likelihood of the child being in an abusive relationship him/herself and hampers healthy development - the others are logical extensions, to a lesser degree). We have to have enough positive images, positive games, positive and healthy discourse about relationships to not just equal the stream of negative imagery and messaging, but to overtake it. Positive, healthy messages, not abusive, harmful, violent messages, have to be in the majority. The norm. It’s nice that the docs finally said so.